Cochrane Db Syst Rev
-
The majority of strokes are due to blockage of an artery in the brain by a blood clot. Clot dissolving (or thrombolytic) drugs may reduce brain damage from the stroke, but may also cause serious bleeding in the brain. Thrombolytic therapy has now been evaluated in several randomised trials in acute ischaemic stroke. ⋯ Thrombolytic therapy increases deaths within the first seven to ten days, and deaths at final follow-up. Thrombolytic therapy also significantly increases symptomatic and fatal intracranial haemorrhage. These risks are offset by a reduction in disability in survivors, so that there is, overall, a significant net reduction in the proportion of patients dead or dependent in activities of daily living. The data from trials using intravenous recombinant tissue Plasminogen Activator, from which there is the most evidence on thrombolytic therapy so far, suggest that it may be associated with less hazard and more benefit. There was heterogeneity between the trials and the optimum criteria to identify the patients most likely to benefit and least likely to be harmed, the agent, dose, and route of administration, are not clear. (ABSTRACT TRUNCATED)
-
Vascular surgeons construct femoro-popliteal bypass grafts, from the groin to the knee, to save limbs that might otherwise require amputation in patients with severe arterial disease, and to improve walking distance in patients with less severe arterial disease. During the operation, the blocked native artery is bypassed using either a section of the patient's own vein (autologous vein), human umbilical vein (HUV), or an artificial graft e.g. Dacron or polytetrafluoroethylene (PTFE). ⋯ There is no clear evidence which type of graft is best for femoro-popliteal grafting. In terms of autologous graft patency, in-situ and reversed vein grafts are equally successful, while HUV performs better than PTFE. A distal vein cuff may improve primary patency for below-knee PTFE femoro-popliteal grafts.
-
Despite widespread use of naltrexone maintenance in many countries for more than a decade, the evidence of its effects has not yet been systematically evaluated. ⋯ The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain target groups (particularly people who are highly motivated), as has been previously described in the literature.
-
Cochrane Db Syst Rev · Jan 2000
ReviewEarly emergency department treatment of acute asthma with systemic corticosteroids.
The airway edema and secretions associated with acute asthma are most effectively treated with anti-inflammatories such as corticosteroids delivered by inhaled, oral, intravenous or intra-muscular routes. There is an unresolved debate about the use of systemic corticorticoids in the early treatment of acute asthma for emergency department patients. ⋯ Use of corticosteroids within 1 hour of presentation to an ED significantly reduces the need for hospital admission in patients with acute asthma. Benefits appear greatest in patients with more severe asthma, and those not currently receiving steroids. Children appear to respond well to oral steroids.
-
Cochrane Db Syst Rev · Jan 2000
ReviewProphylactic vitamin K for vitamin K deficiency bleeding in neonates.
Vitamin K deficiency can cause bleeding in an infant in the first weeks of life. This is known as Hemorrhagic Disease of the Newborn (HDN). HDN is divided into three categories: early, classic and late HDN. Early HDN occurs within 24 hours post partum and falls outside the scope of this review. Classic HDN occurs on days one to seven; common bleeding sites are gastrointestinal, cutaneous, nasal and from a circumcision. Late HDN occurs from week 2-12; the most common bleeding sites are intracranial, cutaneous, and gastrointestinal. Vitamin K is commonly given prophylactically after birth for the prevention of HDN, but the preferred route is uncertain. ⋯ A single dose (1.0 mg) of intramuscular vitamin K after birth is effective in the prevention of classic HDN. Either intramuscular or oral (1.0 mg) vitamin K prophylaxis improves biochemical indices of coagulation status at 1-7 days. Neither intramuscular nor oral vitamin K has been tested in randomized trials with respect to effect on late HDN. Oral vitamin K, either single or multiple dose, has not been tested in randomized trials for its effect on either classic or late HDN.